Background: Recombinant human growth hormone (rhGH) is usually administered via subcutaneous injections. Besides well-known adverse events such as peripheral edema, benign intracranial hypertension, and slipped capital femoral epiphysis, a less known and rare side effect is local lipoatrophy, a phenomenon with an incompletely understood pathophysiology. Here, we report a case of Prader Willi Syndrome (PWS) who presented with local lipoatrophy following hGH.
Case: A 3.5 year old boy was admitted with newly diagnosed PWS. On admission, weight was 17 kg (0.5 SDS), height was 96 (-1.1 SDS), and body mass index (BMI) was 18.5 (2 SDS). rhGH therapy was started at the age of 3.5 years (initial dosage 0.015mg/kg/day, final dosage 0.035mg/kg/day) after his admission. His last BMI was 16.5 (0.6 SDS) with an improvement. Although, no high dosage of rhGH was used, lipoatrophy in both arms was observed at the 2. year of rhGH therapy. No any side effects of rhGH was observed during the follow-up.
Conclusion: Severe local lipoatrophy in injection sites of extremities has only described in a few reports. The present case details a rare side effect of rhGH in genetically proven PWS on an optimal dosage of therapy. Lipoatrophy can be another side effect of rhGH therapy independent from dosage. Moreover, complexities of biosimilar agents in their production, or clinical application have raised questions among experts and some side effects can be occured by biosimilar agents. Further accumulation of genetically proven PWS cases and long-term treatment outcomes of both original molecule and biosimilar agents are required to understand the dynamics of rhGH especially in PWS.
19 Sep 2019 - 21 Sep 2019